VEDLEGG 8. and 2) Luftfartstilsynet (Civil Aviation Authority - Norway) P.O. Box 243 NO-8001 BODØ Fax: - PDF

VEDLEGG 8 Mail or fax to: 1) Statens Havarikommisjon for Transport (Accident Investigation Board Norway (AIBN)) P.O. Box 213 NO-2001 LILLESTRØM Fax: and 2) Luftfartstilsynet (Civil Aviation

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VEDLEGG 8 Mail or fax to: 1) Statens Havarikommisjon for Transport (Accident Investigation Board Norway (AIBN)) P.O. Box 213 NO-2001 LILLESTRØM Fax: and 2) Luftfartstilsynet (Civil Aviation Authority - Norway) P.O. Box 243 NO-8001 BODØ Fax: General information Reporting group Type of report Classification Occurrence Class (Accident/Serious incident/incident) Personal information Norwegian Ident number/organisation number Surname / Organisation name First name Address Postal code City Country Telephone Mobile phone Telefax Organisation Contact person Name Telephone Function/position Occurrence, when and where Local date and time UTC date and time State/nation of occurrence Location of occurrence Occurrence at aerodrome? (Yes/No/Unknown) Location indicator (ICAO-code) Latitude/Longitude of occurrence Aircraft involved? (Yes/No/Unknown) 1 Severity Third party damage? (Yes/No/Unknown) Injury level (Fatal/Seriuos/Minor/None/Unknown) Damage aircraft (Destr/Substant/Minor/None/Unk) Damage aerodrome (Substantial/Minor/None/Unk) 2.0 Aircraft Aircraft registration Manufacturer Type/model Year built Aircraft serial number State of registry Callsign Flight number Aircraft Operation Operator Operation type (commercial/noncommercial) Aircraft description Aircraft category Propulsion type Number of engines Landing gir type EFIS Wake turb. Category Mass group Weight at time of occurrence Maximum take-off mass (MTOM) GNSS installed? (Yes/No/Unknown) Aircraft status Total cycles a/c Aircraft total time (hours) Maintenance documents Airworthiness certificate Fuel Fuel type used and quantity onboard 2 2.1 History of flight Last departure point Location indicator (ICAO-code) Planned destination Location indicator (ICAO-code) Flight phase Occurrence on ground? (Yes/No/Unknown) ATS route ATS route name SID route STAR Speed and altitude Speed Type of speed True airspeed Flight level Altitude (ft) Height (m) Landing Type of landing Electronic landing aids Automatic landing? (Yes/No/Unknown) Forced landing location Approach Visual approach type VASI used Approach RVR status Approach stabilized? (Yes/No/Unknown) Instrument landing procedure A/c approved for precision approach Precision approach category Instrument approach type Approach errors Head-up display HUD installed? (Yes/No/Unknown) HUD used? (Yes/No/Unknown) Person at controls Person at controls Air traffic service Special ATC procedures Controlling agency Actual Cleared 3 Clearence validity Flight plan Current flight rules Current traffic type SSR mode GPWS equipment GPWS installed? (Yes/No/Unknown) GPWS warning given? (Yes/No/Unknown) GPWS warning type 2.2 Aircraft Traffic related Distances and movement Minimal horizontal-estimated (value and unit) Minimal vertical-estimated (value and unit) Vertical profile Height/altitude Bank angle Bank direction Information Traffic Info Type Traffic Info Quality Other a/c seen Visibility restrictions a/c Aircraft lighting ATM aspects Visual approach? (Yes/No/Unknown) VMC climb/descent? (Yes/No/Unknown) Actions Initiator avoiding action A/C avoiding action Risk reduction A/C Safe landing? (Yes/No/Unknown) ACAS ACAS/TCAS installed? (Yes/No/Unknown) RA Geometry RA Type Pilot response to RA Pilot response detail RA Classification Other aircraft Registration Callsign 4 Type of aircraft 2.3 Flight crew Flight crew member Pilot-in-command Co-pilot Norwegian Identity number Category Gender Age Flight crew rest/duty Rest before duty Duty last 24 hours Flight crew experience This a/c type last 24 hours This a/c type last 90 days This a/c type total All a/c types last 24 hours All a/c types last 90 days All a/c types total Flight crew licences Licence type Ratings Validity Registry State issued? (Yes/No/Unknown) Instructor rating? (Yes/No/Unknown) Instrument rating 2.4 System failures ATA-kode Part number Part name Engine information Engine model Time since overhaul Engine cycles Propeller information Make, failed propeller Model, failed propeller 2.5 Injuries Fatal Pilot Co-pilot Cabin crew Other flight crew Seriou s Minor None Unk 5 Passengers Other on A/C Unknown Incapacitation Person incapacitated Reason for incapacity Crew total 3. Weather Weather relevant? (Yes/No/Unknown) Weather conditions Light conditions Visibility Wind Wind speed (value and unit) Speed measured at Wind direction Wind gusts? (Yes/No/Unknown) Maximum gust Clouds Cloud amount Height of cloud base Temperature Air temperature Dew point Precipitation and other weather phenomena Precipitation intensity Precipitation type Characteristics Visibility/Visibility restrictions RVR start RVR middle RVR end Enhet RVR Visibility restrictions Icing Icing intensity A/C approved for icing conditions Wind at take-off & landing Relative wind dir. Windshear Total 6 W/Shear alert install? (Yes/No/Unknown) Crosswind component/unit (value and unit) Headwind loss (value and unit) Turbulence Turbulence type Turbulence intensity Mountain wave intensity Weather briefing/forecast/reports Weather briefing obtained Pilot aware significant weather Weather forecast Report type Report validity Content weather report: 4. Aerodrome Aerodrome type Location indicator (ICAO-code) Aerodrome status Elevation above MSL Helicopter landing area description Helicopter landing area type Helicopter landing area configuration Surface type Runway description Runway width Runway length Runway identifier Runway configuration Runway category Runway slope Runway surface Braking determined by Preparation type Braking action Surface treatment Surface type Contamination T/O or landing on water 7 Obstructions water Wave height Water condition Relation direction-swell 5.0 ATS Unit ATS Unit name Nr. sectors defined Nr. sectors opened Nr. sectors manned ATM relation ATM contribution Effect on ATM service ATM ground safety nets Installed Alerting Reaction STCA MSAW APW A-SMGCS Other Sector identification Sector name Combined operation? (Yes/No/Unknown) Highest flight level Lowest flight level Services provided RTF Frequency Positions in sector / Positions manned Display centre radar Range of radar Sector traffic ( for controller ) Traffic density before - controller Traffic density at - controller Traffic complexity before - controller Traffic complexity at - controller Traffic variation before - controller Sector workload OJTI in progress? (Yes/No/Unknown) Sector capacity Actual sector load A/C on same frequency Stress before - controller Workload - controller 5.1 ATS Unit - Traffic related 8 Horizontal rel movement Rate of closure (value and unit) Military a/c involved? (Yes/No/Unknown) Distances Minimal horizontal-recorded (value and unit) Minimal vertical-recorded (value and unit) Actions ATM action Risk Reduction ATM Aircraft involved Registration Callsign 5.2 ATM Personnel Category ATM personnel Age ATCO Gender - ATCO 6. Airspace Airspace type Airspace name Airspace class Special activities 7. Birdstrike Number of birds Size of birds Part(s) of aircraft Effect on flight Other birdstrike relevant Light conditions Cloud amount Precipitation type Aircraft height Speed (IAS) 8. Dangerous goods Cargo position in aircraft Damage detected Other Propable damage reason Declared goods Shippers name Receivers name Agents name Type of deviation from regulations 9 Documentation (Answer Yes/No/Unknown) Shippers declaration available? Notification to pilot-in-command available? Receivers checklist available?) Air Waybill available? Dangerous goods specification Proper shipping name Technical name UN/ID nr Class/division Packing group Import code 9. Narrative/Description Narrative text: Narrative language Number of attachements Date and signature: 10
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